U.S. Will Reimburse Hospitals That Treat Haitians

Suffering from pseudomonas, a serious infection from a wound, Hermita Longuez, 24, was prepped by Air Force medics for the first military airlift of wounded Haitians since a controversial suspension of the flights last week.Credit
Ruth Fremson/The New York Times

WASHINGTON —The federal government announced on Monday that it would reimburse American hospitals who treat Haitian earthquake victims with life-threatening injuries, making it possible for more hospitals in states outside Florida to consider taking those patients.

The announcement came as a C-130 cargo plane was being sent to carry at least 10 Haitians seriously injured in the earthquake from Port-au-Prince to Palm Beach, Fla., the first military airlift of wounded Haitians since a controversial suspension of the flights last week.

The military medical evacuation flights had been suspended for five days after Florida officials complained that their hospitals were being overwhelmed with patients suffering from devastating burns, head and spinal cord trauma, amputations and other wounds, and that no plan had been put in place to reimburse the hospitals for the care they were providing.

Federal and state officials worked through the weekend to address these concerns. The resumption of flights was announced by the White House Sunday evening, though word about the reimbursement plan did not come until Monday.

“Having received assurances that additional capacity exists both here and among our international partners, we determined that we can resume these critical flights,” Thomas F. Vietor, a White House spokesman, said on Sunday.

He said the aircraft was set to arrive in Port-au-Prince midafternoon Monday and reach Palm Beach International Airport around 8 p.m., with a physician on board to assist the injured, who could number as many as 20.

A statement jointly issued by the Department of Health and Human Services and USAID, the agency coordinating the American response, said both agencies had activated a program that allows American hospitals to take patients with injuries too grave to be treated in the devastation of Haiti and be repaid by the federal government at 110 percent of the rates paid for Medicare patients.

The joint statement said that the airlift was being reserved “for the rare patients with life-threatening conditions that cannot be handled within Haiti or by evacuation to another country.” Haitian hospitals, emergency relief groups, and the United States Navy hospital ship Comfort would refer the patients for airlift.

“There must also be a reasonable chance that the patient can survive the flight and the treatment in the U.S.,“ the statement said.

Maj. James F. Lowe, deputy chief of public affairs for the United States Transportation Command, which manages military airlifts during emergencies, said the patients would be taken to places where facilities would be available to treat their particular injuries. “They match the needs of the patients with the hospitals that have to receive them,” Major Lowe said.

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Air Force medics loaded a patient onto a cargo plane. The military medical evacuation flights had been suspended for five days after Florida officials complained that their hospitals were being overwhelmed with patients.Credit
Ruth Fremson/The New York Times

Major Lowe said other states and countries expressed willingness to receive Haitian patients as well, but he said he could not identify specific sites until flights actually take place.

The destination of the first flight was changed to Palm Beach from Tampa earlier in the day.

The logistics of the evacuation flights are intricate. To minimize risks, the patients are not moved from hospitals or clinics to the airport until an hour or two before the evacuation plane is set to take off.

The mechanism used for reimbursing hospitals, called the National Disaster Medical System, has been used in previous catastrophes like Hurricane Katrina. Hospitals, usually those with more than 100 beds in or near large cities, have entered into voluntary agreements to provide treatment under the plan. The system also enabled 270 doctors, nurses and technicians to travel to Haiti; those teams, the statement said, have already attended to 23,000 people, performed 98 surgical operations and delivered 28 babies as of Monday.

David Halstead, an official with the Florida Division of Emergency Management, said the state and its governor, Charlie Crist, were pleased with the response of federal officials, one that will relieve Florida of the lion’s share of the burden of providing help to the most seriously injured victims.

With a death toll that Haitian officials estimate to be 170,000 and a similar number of injuries, the halt to the evacuations quickly evolved into a roiling controversy, distracting from the enormous efforts made by the United States to help. Aid groups complained that the suspension was putting lives at risk, while officials from Florida to Washington provided conflicting explanations and disclaimed responsibility for the decision.

Governor Crist wrote to the Obama administration last week warning that “Florida’s health care system is quickly reaching saturation” and requesting that the National Disaster Medical System be activated to help with the cost.

The military suspended the flights, saying that Florida hospitals had stopped accepting patients. But Mr. Crist adamantly denied that and, as Florida newspapers began calling it the “airlift scandal,” said he never wanted to stop taking the injured; he only wanted more help.

The White House, acutely aware of the lessons from Hurricane Katrina, stepped in to resolve the problem. Thomas E. Donilon, the president’s deputy national security adviser, led an effort all weekend to address the capacity issue; among other things, the government persuaded other Caribbean nations to help with urgent cases.

Mr. Vietor said the issue of who would pay for treating evacuated Haitians was not the reason for the suspension of the flights, only the concern about whether Florida hospitals could handle the additional patients.

“This wasn’t about cost,” he said. The matter of reimbursement raised by Florida officials is a separate concern, he added, saying, “we’re having ongoing conversations about that issue.”

Until their suspension, the flights had transported hundreds of gravely injured patients, all but a handful to Florida. David Halstead, an official with the Florida Division of Emergency Management, who is coordinating the state’s rescue effort for earthquake victims, said by telephone that Florida has treated 530 Haitian patients and that 190 remained in its hospitals.

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Dr. Phuoc Le, of Boston, top right, and a medevac pilot, transferred 5-year-old Betina Joseph, below left, and a 14-month-old with pneumonia to a private jet for their evacuation to Children’s Hospital in Philadelphia on Sunday, skirting a bureaucratic logjam.Credit
Andres Leighton/Associated Press

“The rest of the states combined have accepted four patients, and it’s not that other states aren’t willing,” he said. “We can certainly accept patients, but there has to be a plan.”

In Port-au-Prince, doctors welcomed the news of resumed airlifts, which they called vital for some of their neediest patients.

“Keeping them in this environment, it’s like you’re sentencing them to a life of misery,” said Dr. Brian Crawford, a volunteer with the International Medical Corps, a relief and development group in Santa Monica, Calif.

He said he hoped that many states, not just Florida, would find a way to share the burden of Haiti’s broken bodies and minds.

He said he had one particular patient in mind: an 11-year-old girl who suffered a severe spinal fracture during the earthquake. She ended up a paraplegic, he said, and a few days ago Dr. Crawford transferred her from the General Hospital here to a charity hospital outside the city, which he hoped would lead to a flight out.

“This could be an open window for her,” he said, referring to the airlifts. “Hopefully it will be.”

The White House said patients were being identified for transfer and evaluated by doctors to ensure that they can handle the flights. In addition, the White House said that the government was arranging for in-flight care for children in need, and that Florida was designating which hospitals could receive the influx of patients. Mr. Vietor said the flights would probably evacuate “a couple hundred of the most severely injured patients.”

Ultimately, though, evacuations are not a long-term solution to the problem. Dr. Barth A. Green, co-founder of Project Medishare for Haiti, a nonprofit group that has been evacuating patients, said the American government has decided to create “a world-class trauma hospital” at the Port-au-Prince airport along with private relief groups. At the same time, a 250-bed hospital for post-operative care and rehabilitation will be completed, and after that a second 250-bed facility for rehabilitation.

“Things are the way they should be again,” he said. “We’re in sync. We are going to show Haiti what we are capable of.”

Confusion disrupted a smaller humanitarian effort involving Haitian children. A Baptist church in Idaho, whose members were among 10 people detained for trying to take 33 children out of Haiti, said Sunday that the team was “falsely arrested” and that the church was trying “to clear up the misunderstanding.”

A statement on the Web site of the church, Central Valley Baptist in Meridian, Idaho, said the team traveled to Haiti to rescue children from orphanages destroyed in the quake. The children, the statement said, were headed for an orphanage across the border in the Dominican Republic. Haitian officials detained the church members out of concern the children might be susceptible to trafficking and said some of the children’s parents might still be alive.